title: Time to readiness for discharge is a valid and reliable measure of short-term recovery after colorectal surgery.
abstract: BACKGROUND
  Short-term recovery after colorectal surgery has been traditionally investigated through length of stay (LOS). However, this measure is influenced by several confounding factors. This study aimed to investigate the construct validity and reliability of assessing the time to achieve standardized discharge criteria (time to readiness for discharge, or TRD) as a measure of short-term recovery. In a secondary analysis, we compared sample size requirements for randomized controlled trials (RCTs) using TRD or LOS as outcome measures.
  
  
  METHODS
  Seventy patients participated in the construct validity study and 21 patients participated in the reliability study. TRD was defined as the number of days to achieve discharge criteria previously defined by consensus. Construct validity was investigated by testing six hypothesis based on the assumption that TRD measures short-term recovery. Reliability was calculated by comparing measures of TRD by two independent assessors. Variability estimates (standard deviations) of LOS and TRD were used for sample size calculations.
  
  
  RESULTS
  Five of the six hypotheses were supported by the data (p < 0.05). Interobserver reliability was excellent (ICC2.1 = 0.99). Sample size estimations showed that RCTs using TRD as an outcome measure require approximately 23 % less participants compared to RCTs using LOS.
  
  
  CONCLUSIONS
  The results of this research support the construct-validity and reliability of TRD as a measure of short-term recovery. Using TRD as an alternative to LOS may reduce sample size requirements in future RCTs.
authors.affiliation: Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, 200 Berkeley Street, Carlton, VIC, 3010, Australia, julio.fiore@live.com.
authors.forename: Julio F
authors.initials: JF
authors.lastname: Fiore
authors.forename: Ian G
authors.initials: IG
authors.lastname: Faragher
authors.forename: Andrea
authors.initials: A
authors.lastname: Bialocerkowski
authors.forename: Laura
authors.initials: L
authors.lastname: Browning
authors.forename: Linda
authors.initials: L
authors.lastname: Denehy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003082:Colectomy / Q000534:rehabilitation*; D003125:Colostomy / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000534:rehabilitation*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010351:Patient Discharge / Q000592:standards* / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000379:methods / Q000592:standards; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D012007:Rectum / Q000601:surgery*; D015203:Reproducibility of Results; D018401:Sample Size; D013997:Time Factors